Journal of Dental & Allied Sciences 2012;1(1)
Expert Speak
Medicolegal Aspects of Dental Practice - An Overview
Shilpa Pharande
Introduction
In this current era of consumer satisfaction, dentists are
increasingly facing legal challenges from dissatisfied patients.
With this changing scenario, doctors have to adapt to the
situation and may have to face such legal tangles, which is
intangible and disturbing sometimes. It is imperative that all
dentists should be aware of the medico legal aspects of the
field.
Negligence
We dentist are expected to have a sound knowledge of our
profession and science including the recent advances. So that
the patient is assured that a reasonable degree of care and
caution will be taken during the treatment.
As defined by Alderson1 “ Negligence is the omission to do
something which a reasonable man, guided upon those
considerations which ordinarily regulate the conduct of human
affairs, would do, or doing something which a prudent and
reasonable man would not do”.
So to say that an act is negligent following factorts should be
present:
1. That the doctor owed certain standard of care and duty.
2. Doctor failed to perform his duty and necessary care was
not taken
3. Due to lack of care patient suffered injury
4. There should be close proximity between negligent act and
the resultant injury.
Therefore to have a viable dental malpractice lawsuit one must
have unintentionally or intentionally committed an act that a
reasonable dentist would not have done. A dentist cannot be
held liable just because a better treatment option was available
or due to lack of special skills as far as basic standard of care
2
was practiced by him.
Stringently, the duties of care for dentist are:–
deciding whether to undertake the case, what treatment to give,
and Duty of care in administration of that treatment.
Nevertheless, a simple lack of care, an error of judgment or an
accident is not a proof of negligence on the part of medical
professional.
3
Hence negligence is not a specific term but is comparison of all
the facts from legal point of view.
Some Common Dental Negligence occurring are:
1. Injuries to the nerves of the tongue, jaw, chin and lips,
(permanent or temporary) while performing extractions.
Post Graduate Diploma in Medico-Legal Science,
Member of World Association for Medical Law (Belgium)
* Lecturer, Dept. of Orthodontics & Dentofacial Orthopaedics,
Sinhgad Dental College & Hospital, Pune - 411 041, India
e-mail: drshilpapharande@gmail.com
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2. Mandibular fractures during extraction
3. Loss of taste sensation due to lingual nerve damage
4. Injury from improper use of dental instruments e.g.
broken RC instrument (file, reamer) left in root canal
sometimes causing periapical infection.
5. Failure to diagnose precancerous lesions in oral cavity
6. Root resorption occurring due to excessive forces applied
during orthodontic treatment
7. Failure to obtain proper informed consent from the patient
explaining him the available options, advantages and ill
effects of the treatment.
8. Ill-fitting dentures due to a some faulty techniques
causing pain and discomfort to the patient
9. Not referring the patient to the specialist when required
10. Practicing dentistry without a DCI approved dental
degree and registration
11. Carrying out surgical procedure without having sufficient
backup in the clinic or hospital.
Some Interesting Dental Cases
1. Parmley vs Parmley (1945) 4DLR81. Dentist was held
liable for extracting few more teeth in upper arch without
patient consent though they had advanced periodontitis
2. Garner vs Marrell (1953) Times 31 Oct. CA. dentist held
liable for the death of the patient as a piece of gauze slipped
into his throat during extraction causing asphyxia.
3. Ishwardas vs VK Gupta (1992) CPJ118NC. Soreness and
ulcers caused due to ill-fitting denture, dentist was held
liable.
Conclusion
Because I am, first and foremost, an orthodontist, I have tried to
offer you a unique perspective on Medico-Legal issues, not
simply from the point of view of a legal professional, but from
the point of view of a dentist, just like you. After all, life isn't
always straightforward and things can go wrong, but if you're
prepared, and fully equipped to deal with the unexpected, you
can minimise the disruption any legal issues will have on you
and your practice.
When it comes to Medico-Legal issues, my philosophy is to
provide advice and assistance to practitioners in order to
support them, and to minimise disruption to their practices, as
well as to uphold the professionalism and reputation of
dentistry as a whole.
References
1. Medical law for dental surgeon by George Paul, chapter no 5, pg no 29.
2. Nayak RK. Consumer Protection Law in India, the Indian Law
Institute, 1991. Tripathi NM Pvt. Ltd.
3. www.legalserviceindia.com/article/print.asp?id=178